1887

Abstract

Resistance rates to azoles and echinocandins of spp. increased over the last decade.

Widespread use of antifungals could lead to development and dissemination of resistant spp.

To identify risk factors for isolation of spp. non-susceptible to either fluconazole or echinocandins.

All patients hospitalized in the Intensive Care Unit (ICU) of the University General Hospital of Patras, Greece with spp. isolated from clinical specimens during a ten-year period (2010–19) were included. isolates were identified using Vitek-2 YST card. Consumption of antifungals was calculated.

During the study period, 253 isolates were included. . non- predominated (64.4 %) with being the most commonly isolated (42.3 %) followed by (nomenclatural change to ; 8.7 %) and (11.9 %). Among all isolates, 45.8 and 28.5 % were non-susceptible and resistant to fluconazole, respectively. Concerning echinocandins, 8.7 % of isolates were non-susceptible to at least one echinocandin (anidulafungin or micafungin) and 3.1 % resistant. Multivariate analysis revealed that hospitalization during 2015–19, as compared to 2010–14, isolate being non- or non-susceptible to at least one echinocandin was associated with isolation of fluconazole non-susceptible isolate. Administration of echinocandin, isolate being or , or spp. non-susceptible to fluconazole were independently associated with isolation of spp. non-susceptible to at least one echinocandin. Fluconazole’s administration decreased during the study period, whereas liposomal-amphotericin B’s and echinoncandins’ administration remained stable.

Fluconazole’s non-susceptibility increased during the study period, despite the decrease of its administration. Although echinocandins’ administration remained stable, non-susceptibility among spp. increased.

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2021-08-25
2024-04-14
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References

  1. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A et al. International study of the prevalence and outcomes of infection in intensive care units. Jama 2009; 302:2323–2329 [View Article] [PubMed]
    [Google Scholar]
  2. Bassetti M, Giacobbe DR, Vena A, Trucchi C, Ansaldi F et al. Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project. Crit Care 2019; 23:219 [View Article] [PubMed]
    [Google Scholar]
  3. Papadimitriou-Olivgeris M, Spiliopoulou A, Kolonitsiou F, Bartzavali C, Lambropoulou A et al. Increasing incidence of candidaemia and shifting epidemiology in favor of Candida non-albicans in a 9-year period (2009-2017) in a university Greek hospital. Infection 2019; 47:209–216 [View Article] [PubMed]
    [Google Scholar]
  4. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1–50 [View Article] [PubMed]
    [Google Scholar]
  5. Ullmann AJ, Cornely OA, Donnelly JP, Akova M, Arendrup MC et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: developing European guidelines in clinical microbiology and infectious diseases. Clin Microbiol Infect 2012; 18:1–8 [View Article] [PubMed]
    [Google Scholar]
  6. Pfaller MA, Jones RN, Castanheira M. Regional data analysis of Candida non-albicans strains collected in United States medical sites over a 6-year period, 2006-2011. Mycoses 2014; 57:602–611 [View Article] [PubMed]
    [Google Scholar]
  7. Lamoth F, Lockhart SR, Berkow EL, Calandra T. Changes in the epidemiological landscape of invasive candidiasis. J Antimicrob Chemother 2018; 73:i13i4 [View Article]
    [Google Scholar]
  8. Pfaller MA, Diekema DJ, Turnidge JD, Castanheira M, Jones RN. Twenty years of the SENTRY antifungal surveillance program: Results for Candida species from 1997-2016. Open Forum Infect Dis 2019; 6:S79–S94 [View Article] [PubMed]
    [Google Scholar]
  9. Tapia GG, Razonable RR, Eckel-Passow JE, Lahr BD, Afessa B et al. A scoring model of factors associated with candida glabrata candidemia among critically ill patients. Mycoses 2012; 55:228–236 [View Article] [PubMed]
    [Google Scholar]
  10. Kronen R, Hsueh K, Lin C, Powderly WG, Spec A. Creation and assessment of a clinical predictive calculator and mortality associated with Candida krusei bloodstream infections. Open Forum Infect Dis 2018; 5:ofx253 [View Article] [PubMed]
    [Google Scholar]
  11. Borman AM, Johnson EM. Name changes for fungi of medical importance, 2018 to 2019. J Clin Microbiol 2021; 59: [View Article] [PubMed]
    [Google Scholar]
  12. Papadimitriou-Olivgeris M, Andrianaki AM, Marangos M, Sipsas N, Apostolidi EA et al. Hospital-wide antifungal prescription in Greek hospitals: a multicenter repeated point-prevalence study. Eur J Clin Microbiol Infect Dis 2020; 39:243–248 [View Article]
    [Google Scholar]
  13. Siopi M, Tarpatzi A, Kalogeropoulou E, Damianidou S, Vasilakopoulou A et al. Epidemiological trends of fungemia in Greece with a focus on candidemia during the recent financial crisis: A 10-year survey in a tertiary care academic hospital and review of literature. Antimicrob Agents Chemother 2020; 64: [View Article]
    [Google Scholar]
  14. Papadimitriou-Olivgeris M, Spiliopoulou A, Fligou F, Spiliopoulou I, Tanaseskou L. Risk factors and predictors of mortality of candidaemia among critically ill patients: role of antifungal prophylaxis in its development and in selection of non-albicans species. Infection 2017; 45:651–657 [View Article] [PubMed]
    [Google Scholar]
  15. Institute CaLS Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts, 4th informational supplement, M27-S4. Wayne: 2012
    [Google Scholar]
  16. Jabeen K, Kumar H, Farooqi J, Mehboob R, Brandt ME et al. Agreement of direct antifungal susceptibility testing from positive blood culture bottles with the conventional method for Candida species. J Clin Microbiol 2016; 54:343–348 [View Article] [PubMed]
    [Google Scholar]
  17. Aigner M, Erbeznik T, Gschwentner M, Lass-Flörl C. Etest and sensititre yeastone susceptibility testing of echinocandins against Candida species from a single center in Austria. Antimicrob Agents Chemother 2017; 61: [View Article]
    [Google Scholar]
  18. Cretella D, Barber KE, King ST, Stover KR. Comparison of susceptibility patterns using commercially available susceptibility testing methods performed on prevalent Candida spp. J Med Microbiol 2016; 65:1445–1451 [View Article] [PubMed]
    [Google Scholar]
  19. WHO Collaborating Centre for Drug Statistics Methodology Guidelines for ATC classification and DDD assignment. 2021. Oslo; 2020 https://www.whocc.no/atc_ddd_index_and_guidelines/guidelines/ accessed 12 Jan 2021
  20. Chakrabarti A, Sood P, Rudramurthy SM, Chen S, Kaur H et al. Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive Care Med 2015; 41:285–295 [View Article] [PubMed]
    [Google Scholar]
  21. Schroeder M, Weber T, Denker T, Winterland S, Wichmann D et al. Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis. Ann Intensive Care 2020; 10:142 [View Article] [PubMed]
    [Google Scholar]
  22. Baldesi O, Bailly S, Ruckly S, Lepape A, L’Heriteau F et al. ICU-acquired candidaemia in France: Epidemiology and temporal trends, 2004-2013 - A study from the REA-RAISIN network. J Infect 2017; 75:59–67 [View Article] [PubMed]
    [Google Scholar]
  23. Mete B, Zerdali EY, Aygun G, Saltoglu N, Balkan II et al. Change in species distribution and antifungal susceptibility of candidemias in an intensive care unit of a university hospital (10-year experience. Eur J Clin Microbiol Infect Dis 2020; 40:325–333 [View Article]
    [Google Scholar]
  24. Arastehfar A, Hilmioğlu-Polat S, Daneshnia F, Hafez A, Salehi M et al. Recent increase in the prevalence of fluconazole-non-susceptible Candida tropicalis blood isolates in Turkey: Clinical implication of azole-non-susceptible and fluconazole tolerant phenotypes and genotyping. Front Microbiol 2020; 11:587278 [View Article] [PubMed]
    [Google Scholar]
  25. Tumbarello M, Sanguinetti M, Trecarichi EM, La Sorda M, Rossi M et al. Fungaemia caused by Candida glabrata with reduced susceptibility to fluconazole due to altered gene expression: risk factors, antifungal treatment and outcome. J Antimicrob Chemother 2008; 62:1379–1385 [View Article] [PubMed]
    [Google Scholar]
  26. Wang Y, Yang Q, Chen L, Liu L, Hao R et al. Cross-resistance between voriconazole and fluconazole for non-albicans Candida infection: a case-case-control study. Eur J Clin Microbiol Infect Dis 2017; 36:2117–2126 [View Article]
    [Google Scholar]
  27. Thomaz DY, de Almeida JN Jr, Lima GME, Nunes M de O, Camargo CH et al. An azole-resistant candida parapsilosis outbreak: Clonal persistence in the intensive care unit of a brazilian teaching hospital. Front Microbiol 2018; 9:2997 [View Article] [PubMed]
    [Google Scholar]
  28. Arastehfar A, Daneshnia F, Najafzadeh MJ, Hagen F, Mahmoudi S et al. Evaluation of molecular epidemiology, clinical characteristics, antifungal susceptibility profiles, and molecular mechanisms of antifungal resistance of iranian candida parapsilosis species complex blood isolates. Front Cell Infect Microbiol 2020; 10:206 [View Article] [PubMed]
    [Google Scholar]
  29. Lo H-J, Tsai SH, Chu WL, Chen YZ, Zhou ZL et al. Fruits as the vehicle of drug resistant pathogenic yeasts. J Infect 2017; 75:254–262 [View Article] [PubMed]
    [Google Scholar]
  30. Yang YL, Lin CC, Chang TP, Lauderdale TL, Chen HT et al. Comparison of human and soil Candida tropicalis isolates with reduced susceptibility to fluconazole. PloS one 2012; 7:e34609
    [Google Scholar]
  31. Beyda ND, John J, Kilic A, Alam MJ, Lasco TM et al. FKS mutant Candida glabrata: risk factors and outcomes in patients with candidemia. Clin Infect Dis 2014; 59:819–825 [View Article] [PubMed]
    [Google Scholar]
  32. Vallabhaneni S, Cleveland AA, Farley MM, Harrison LH, Schaffner W et al. Epidemiology and risk factors for echinocandin nonsusceptible candida glabrata bloodstream infections: Data from a large multisite population-based candidemia surveillance program, 2008-2014. Open Forum Infect Dis 2015; 2:ofv163 [View Article] [PubMed]
    [Google Scholar]
  33. Coste AT, Kritikos A, Li J, Khanna N, Goldenberger D et al. Emerging echinocandin-resistant Candida albicans and glabrata in Switzerland. Infection 2020; 48:761–766 [View Article] [PubMed]
    [Google Scholar]
  34. Jensen RH, Astvad KM, Silva LV, Sanglard D, Jorgensen R et al. Stepwise emergence of azole, echinocandin and amphotericin B multidrug resistance in vivo in Candida albicans orchestrated by multiple genetic alterations. J Antimicrob Chemother 2015; 70:2551–2555 [View Article] [PubMed]
    [Google Scholar]
  35. Ben Abdeljelil J, Saghrouni F, Khammari I, Gheith S, Fathallah A et al. Investigation of a cluster of Candida albicans invasive candidiasis in a neonatal intensive care unit by pulsed-field gel electrophoresis. Sci World J 2012; 2012:138989 [View Article] [PubMed]
    [Google Scholar]
  36. Ruiz-Diez B, Martinez V, Alvarez M, Rodriguez-Tudela JL, Martinez-Suarez JV. Molecular tracking of Candida albicans in a neonatal intensive care unit: long-term colonizations versus catheter-related infections. J Clin Microbiol 1997; 35:3032–3036 [View Article] [PubMed]
    [Google Scholar]
  37. Posteraro B, Efremov L, Leoncini E, Amore R, Posteraro P et al. Are the conventional commercial yeast identification methods still helpful in the era of new clinical microbiology diagnostics? A meta-analysis of their accuracy. J Clin Microbiol 2015; 53:2439–2450 [View Article] [PubMed]
    [Google Scholar]
  38. Thomaz DY, de Almeida JN, Sejas ONE, Del Negro GMB, Carvalho G et al. Environmental clonal spread of azole-resistant Candida parapsilosis with ERG11-Y132F mutation causing a large candidemia outbreak in a brazilian cancer referral center. J Fungi (Basel) 2021; 7: [View Article] [PubMed]
    [Google Scholar]
  39. Fekkar A, Blaize M, Bouglé A, Normand AC, Raoelina A et al. Hospital outbreak of fluconazole-resistant Candida parapsilosis: arguments for clonal transmission and long-term persistence. Antimicrob Agents Chemother 2021; 65: [View Article]
    [Google Scholar]
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